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Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre

Published on Apr 28, 2010in British Journal of Surgery5.572
· DOI :10.1002/bjs.7071
Thilo Welsch5
Estimated H-index: 5
(University Hospital Heidelberg),
M. Borm1
Estimated H-index: 1
(University Hospital Heidelberg)
+ 3 AuthorsMoritz N. Wente4
Estimated H-index: 4
(University Hospital Heidelberg)
Sources
Abstract
Background: Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy. The International Study Group of Pancreatic Surgery (ISGPS) definition of DGE has not been evaluated and validated in a high-volume centre. Methods: Complete data sets including assessment of gastric emptying were identified from a database of patients undergoing pancreatoduodenectomy between 2001 and 2008. Factors associated with DGE (grades A, B and C) were assessed by univariable and multivariable analyses. Results: DGE occurred in 340 (44·5 per cent) of 764 patients. Median hospital stay was significantly prolonged in patients with DGE: 13, 21 and 40 days for grades A, B and C respectively versus 11 days for patients without DGE. DGE was associated with prolonged intensive care unit (ICU) admission (at least 2 days): 20·6, 28·6 and 61·8 per cent of those with grades A, B and C respectively versus 9·4 per cent of patients without DGE. Factors independently influencing DGE grade A were female sex, preoperative heart failure and major complications (grade III–V). Validation of the DGE definition revealed that DGE grades A and B were associated with interventional treatment in 20·1 and 44·4 per cent of patients. Conclusion: The ISGPS DGE definition is feasible and applicable in patients with an uneventful postoperative course. Major postoperative complications and ICU treatment, however, might limit its usefulness. The identified risk factors for DGE are not amenable to perioperative improvement. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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References32
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#1Joon Seong Park (Yonsei University)H-Index: 19
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Abstract Background Pancreatic fistula (PF) is one of the most common postoperative complications of pancreatoduodenectomy (PD). A recent International Study Group on Pancreatic Fistula (ISGPF) definition grades the severity of PF according to the clinical impact on the patient's hospital course. Although PF is generally treated conservatively (grade A), some cases may require interventional procedures (grade B) or may be life-threatening and necessitate emergency reoperation (grade C). The aim ...
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While mortality following pancreaticoduodenectomy has progressively decreased over the last decade, its morbidity, especially the development of pancreatic fistula, has remained constant over the years. However, high volume centers and individual surgeons report a major decrease in the rate of post-operative pancreatic fistulas. Technical refinements are crucial to reduce, and if possible prevent, the development of pancreatic fistula. No uniformity of opinion exists as to the method of pancreat...
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Pancreatic cancer remains the fourth leading cause of cancer deaths overall in the United States, killing an estimated 31,800 people in 2005.1 A number of single-institution and single-state reports have described an improvement in perioperative mortality in the 1980s and 1990s for high-risk cancer resections, including pancreaticoduodenectomy (PD).2–4 In the state of Maryland, concurrent with a move toward statewide regionalization of PD, a decrease in perioperative mortality was described over...
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Concepts in “fast-track” surgery, which provide optimal perioperative care, have been proven to significantly reduce complication rates and decrease hospital stay. This study explores whether fast-track concepts can also be safely applied and improve the outcomes of major pancreatic resections. Perioperative data from 255 consecutive patients, who underwent pancreatic resection by means of fast-track surgery in a high-volume medical center, were analyzed using univariate and multivariate models....
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